Present Situation and Progress of Diagnosis and Treatment of Gastrointestinal Stromal Tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGXian-jin ¹ , CHENJia-hui ² , DUJiang ^1,3 ,  WANGChong-shu ^1,3

1. The First Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
2. Department of Gastrointestinal Surgery, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
3. Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding author：

WANGChong-shu, Email: chongs-wang@163.com

Keywords：

Gastrointestinal stromal tumor; Diagnosis; Treatment; C-kit gene; Platelet-derived growth factor receptor alpha

DOI：

10.7507/1007-9424.20140250

Video：

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Objective To summarize the pathogenesis and epidemiology features of gastrointestinal stromal tumor(GIST), explore its diagnosis and therapy, and analyze its prognosis. Method The pertinent literatures about the pathogenesis, epidemiology features, diagnosis, therapy, and prognosis of GIST in recent years were reviewed. Results GIST was non-epithelial tumor which derived from interstitial cells of Cajal, was the most common mesenchymal tumor about accounting for 1%-3% in the digestive tract tumor. The median onset age of patients with GIST was 40-60 years. The gastric stromal tumor was about 60% in all the digestive tract tumor. The current consensus statement was that there was a relation between the pathogenesis of the GIST and proto-oncogene c-kit or platelet-derived growth factor receptor alpha(PDGFRα)gene mutation. But the mutations of PDGFRαand c-kit gene did not emerge at the same time in the same patient. The clinical manifestations of GIST were not specific, and the diagnosis mainly depended on endoscope and image technology, the correct diagnosis depended on pathological examination. The treatment of GIST was given priority of surgery and molecular targeted drug therapy, and the prognosis was closely related to risk assessment stratify of GIST. Conclusions GISTs are mesenchymal tumors that has a potential of malignant transformation, the risk classification criteria for aggressive clinical course of primary GIST is an important indication for guiding the clinical therapy and prognostic evaluation. Further research would be needed in prevention, diagnosis, treatment, and relapse prevention of GIST.

Citation： YANGXian-jin, CHENJia-hui, DUJiang, WANGChong-shu. Present Situation and Progress of Diagnosis and Treatment of Gastrointestinal Stromal Tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 1040-1045. doi: 10.7507/1007-9424.20140250 Copy

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3.	Lux ML, Rubin BP, Biase TL, et al. KIT extracellular and kinase domain mutations in gastrointestinal stromal tumors[J]. Am J Pathol, 2000, 156(3):791-795.
4.	Doyle LA, Hornick JL. Gastrointestinal stromal tumours:from KIT to succinate dehydrogenase[J]. Histopathology, 2014, 64(1):53-67.
5.	Beadling C, Patterson J, Justusson E, et al. Gene expression of the IGF pathway family distinguishes subsets of gastrointestinal stromal tumors wild type for KIT and PDGFRA[J]. Cancer Med, 2013, 2(1):21-31.
6.	王彦丽, 赵向荣, 白辰光, 等.胃肠道间质瘤组织中PDGFRα和C-kit基因突变和蛋白表达的关系[J].世界华人消化杂志, 2007, 15(21):2300-2305.
7.	Miettinen M, Monihan JM, Sarlomo-Rikala M, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery:clinicopathologic and immunohistochemical study of 26 cases[J]. Am J Surg Pathol, 1999, 23(9): 1109-1118.
8.	Heinrich MC, Rubin BP, Longley BJ, et al. Biology and genetic aspects of gastrointestinal stromal tumors:KIT activation and cytogenetic alterations[J]. Hum Pathol, 2002, 33(5):484-495.
9.	Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors presenting as omental masses-A clinicopathologic analysis of 95 cases[J]. Am J Surg Pathol, 2009, 33(9):1267-1275.
10.	Miettinen M, Makhlouf H, Sobin LH, et al. Gastrointestinal stromal tumors of the jejunum and ileum-A clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up[J]. Am J Surg Pathol, 2006, 30(4):477-489.
11.	Corless CL, Schroeder A, Griffith D, et al. PDGFRA mutations in gastrointestinal stromal tumors:frequency, spectrum and in vitro sensitivity to imatinib[J]. J Clin Oncol, 2005, 23(23): 5357-5364.
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14.	Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach-A clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up[J]. Am J Surg Pathol, 2005, 29(1):52-68.
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23.	Levy AD, Remotti HE, Thompson WM, et al. Gastrointestinal stromal tumors:radiologic features with pathologic correlation[J]. Radiographics, 2003, 23(2):283-304, 456.
24.	刘长青, 谭诗云, 李军华, 等.超声内镜联合CT对胃间质瘤的临床诊断价值[J].世界华人消化杂志, 2012, 20(25):2404-2406.
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33.	Dematteo RP, Ballman KV, Antonescu CR, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour:a randomised, double-blind, placebocontrolled trial[J]. Lancet, 2009, 373(9669):1097-1104.
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36.	师英强, 杜春燕, 周烨, 等.胃肠间质瘤联合脏器切除22例疗效分析[J].中国实用外科杂志, 2008, 28(4):273-274.
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38.	Winfield RD, Hochwald SN, Vogel SB, et al. Presentation and management of gastrointestinal stromal tumors of the duodenum[J]. Am Surg, 2006, 72(8):719-723.
39.	陈凛, 李涛.十二指肠间质瘤临床诊断与治疗[J].中国实用外科杂志, 2008, 28(11):945-946.
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1. Mazur MT, Clark HB. Gastric stromal tumors. Reappraisal of histogenesis[J]. Am J Surg Pathol, 1983, 7(6):507-519.
2. CSCO胃肠间质瘤专家委员会.中国胃肠间质瘤诊断治疗专家共识(2011年版)[J].临床肿瘤学杂志, 2011, 16(9):836-844.
3. Lux ML, Rubin BP, Biase TL, et al. KIT extracellular and kinase domain mutations in gastrointestinal stromal tumors[J]. Am J Pathol, 2000, 156(3):791-795.
4. Doyle LA, Hornick JL. Gastrointestinal stromal tumours:from KIT to succinate dehydrogenase[J]. Histopathology, 2014, 64(1):53-67.
5. Beadling C, Patterson J, Justusson E, et al. Gene expression of the IGF pathway family distinguishes subsets of gastrointestinal stromal tumors wild type for KIT and PDGFRA[J]. Cancer Med, 2013, 2(1):21-31.
6. 王彦丽, 赵向荣, 白辰光, 等.胃肠道间质瘤组织中PDGFRα和C-kit基因突变和蛋白表达的关系[J].世界华人消化杂志, 2007, 15(21):2300-2305.
7. Miettinen M, Monihan JM, Sarlomo-Rikala M, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery:clinicopathologic and immunohistochemical study of 26 cases[J]. Am J Surg Pathol, 1999, 23(9): 1109-1118.
8. Heinrich MC, Rubin BP, Longley BJ, et al. Biology and genetic aspects of gastrointestinal stromal tumors:KIT activation and cytogenetic alterations[J]. Hum Pathol, 2002, 33(5):484-495.
9. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors presenting as omental masses-A clinicopathologic analysis of 95 cases[J]. Am J Surg Pathol, 2009, 33(9):1267-1275.
10. Miettinen M, Makhlouf H, Sobin LH, et al. Gastrointestinal stromal tumors of the jejunum and ileum-A clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up[J]. Am J Surg Pathol, 2006, 30(4):477-489.
11. Corless CL, Schroeder A, Griffith D, et al. PDGFRA mutations in gastrointestinal stromal tumors:frequency, spectrum and in vitro sensitivity to imatinib[J]. J Clin Oncol, 2005, 23(23): 5357-5364.
12. Lamba G, Gupta R, Lee B, et al. Current management and prognostic features for gastrointestinal stromal tumor (GIST)[J]. Exp Hematol Oncol, 2012, 1(1):14.
13. Beham AW, Schaefer IM, Schüler P, et al. Gastrointestinal stromal tumors[J]. Int J Colorectal Dis, 2012, 27(6):689-700.
14. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach-A clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up[J]. Am J Surg Pathol, 2005, 29(1):52-68.
15. 张启瑜.钱礼腹部外科学[M].北京:人民卫生出版社, 2006: 230-231.
16. 杨弘鑫, 陈秀峰, 张波, 等. 217例胃间质瘤的临床特点与诊治[J].中国普外基础与临床杂志, 2012, 19(9):951-956.
17. 胡月颖.胃肠道间质瘤的影像学诊断[J].医学理论与实践, 2013, 26(11):1440-1442.
18. 宗春华, 徐雷鸣, 陈惠芳.内镜超声检查术在胃间质瘤中的诊断价值[J].中国内镜杂志, 2006, 12(9):917-918, 921.
19. 李建卫, 吴松松, 朱琳, 等.彩色多普勒超声鉴别诊断胃间质瘤与胃癌[J].中国医学影像技术, 2011, 27(6):1227-1230.
20. 郑育聪, 李健丁, 张瑞平.胃肠道间质瘤的影像学研究进展[J].世界华人消化杂志, 2010, 18(1):49-53.
21. 李成明, 张瑜, 祝青松, 等. CT诊断胃间质瘤[J].中国医学影像学杂志, 2008, 16(2):145-146.
22. 易亚辉, 周建胜.胃间质瘤的CT和MRI诊断[J].中国医学影像学杂志, 2006, 14(5):336-340.
23. Levy AD, Remotti HE, Thompson WM, et al. Gastrointestinal stromal tumors:radiologic features with pathologic correlation[J]. Radiographics, 2003, 23(2):283-304, 456.
24. 刘长青, 谭诗云, 李军华, 等.超声内镜联合CT对胃间质瘤的临床诊断价值[J].世界华人消化杂志, 2012, 20(25):2404-2406.
25. 王钧. 32例胃肠道间质瘤的病理学及免疫组化研究[J].当代医学, 2012, 18(12):4-5.
26. 哈英娣, 李青清, 苏勤军, 等.胃间质瘤的临床病理改变[J].现代肿瘤医学, 2008, 16(8):1346-1348.
27. 戎龙, 万远廉, 年卫东, 等.胃间质瘤63例临床分析[J].中华胃肠外科杂志, 2009, 12(1):24-27.
28. Espinosa I, Lee CH, Kim MK, et al. A novel monoclonal antibody against DOG1 is a sensitive and specific marker for gastrointestinal stromal tumors[J]. Am J Surg Pathol, 2008, 32(2): 210-218.
29. 王卓才, 赖日权, 黄小让, 等.胃间质瘤CD34, SMA, S-100蛋白表达与细胞增殖和预后关系[J].广东医学, 2002, 23(8): 823-824.
30. Tsujimura T, Makiishi-Shimobayashi C, Lundkvist J, et al. Expression of the intermediate filament nestin in gastrointestinal stromal tumors and interstitial cells of Cajal[J]. Am J Pathol, 2001, 158(3):817-823.
31. Kang KY, Lee W. Gastrointestinal stromal tumor with extensive lymphatic metastasis:a case report[J]. J Gastric Cancer, 2013, 13(3):192-195.
32. 何裕隆.胃肠间质瘤临床病例解析[J].国际外科学杂志, 2007, 34(5):354-358.
33. Dematteo RP, Ballman KV, Antonescu CR, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour:a randomised, double-blind, placebocontrolled trial[J]. Lancet, 2009, 373(9669):1097-1104.
34. 熊炳贤, 李红浪, 曾飞, 等.胃间质细胞瘤18例诊治分析[J].中国普通外科杂志, 2004, 13(9):670-672.
35. 柴宇啸, 曲兴龙, 李雷, 等.胃间质瘤16例诊治分析[J].中国普通外科杂志, 2009, 18(10):1091-1093.
36. 师英强, 杜春燕, 周烨, 等.胃肠间质瘤联合脏器切除22例疗效分析[J].中国实用外科杂志, 2008, 28(4):273-274.
37. 魏志刚, 韩超, 李健丁.胃肠道间质瘤的诊断治疗[J].世界华人消化杂志, 2010, 18(1):65-69.
38. Winfield RD, Hochwald SN, Vogel SB, et al. Presentation and management of gastrointestinal stromal tumors of the duodenum[J]. Am Surg, 2006, 72(8):719-723.
39. 陈凛, 李涛.十二指肠间质瘤临床诊断与治疗[J].中国实用外科杂志, 2008, 28(11):945-946.
40. 何裕隆.胃肠间质瘤外科治疗的选择[J].中华胃肠外科杂志, 2006, 9(1):15-16.
41. 师英强, 杜春燕.胃肠间质瘤的外科治疗问题[J].肿瘤研究与临床, 2006, 18(8):518-520.
42. 张旭, 戎铁华, 吴秋良, 等.食管间质瘤与平滑肌肿瘤的临床鉴别及治疗[J].癌症, 2006, 25(7):901-905.
43. Hornick LJ, Fletcher CD. The role of KIT in the management of patients with gastrointestinal stromal tumors[J]. Hum Pathol, 2007, 38(5):679-687.
44. 张文, 陈治宇, 王磊苹, 等.伊马替尼治疗晚期胃肠道间质瘤[J].中国癌症杂志, 2008, 18(1):42-45.
45. Zalcberg JR, Verweij J, Casali PG, et al. Outcome of patients with advanced gastrointestinal stromal tumours crossing over to a daily imatinib dose of 800 mg after progression on 400 mg[J]. Eur J Cancer, 2005, 41(12):1751-1757.
46. 周辛欣, 季峰.胃肠道间质瘤分子靶向治疗研究进展[J].国际消化病杂志, 2009, 29(5):346-348.
47. 王春萌, 师英强, 傅红, 等.甲磺酸伊马替尼治疗胃肠道间质瘤的疗效及安全性分析[J].中国癌症杂志, 2008, 18(11): 873-875.
48. Demetri GD, van Oosterom AT, Garrett CR, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib:a randomised controlled trial[J]. Lancet, 2006, 368(9544):1329-1338.
49. Kefeli U, Benekli M, Sevinc A, et al. Efficacy of sorafenib in patients with gastrointestinal stromal tumors in the third-or fourth-line treatment:A retrospective multicenter experience[J]. Oncol Lett, 2013, 6(2):605-611.
50. 李嘉, 李昂, 张钰鹏, 等.胃肠间质瘤并广泛转移[J].中国实用外科杂志, 2011, 31(2):183-185.
51. 高志冬, 叶颖江, 全美盈, 等.胃肠间质瘤肝转移诊治进展[J].中国实用外科杂志, 2009, 29(8):693-696.
52. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor[J]. Hum Pathol, 2008, 39(10):1411-1419.
53. 李增辉, 秦岭, 李荣, 等. 212例胃肠间质瘤的临床病理特征及预后分析[J].热带医学杂志, 2012, 12(5):542-546, 565.
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Present Situation and Progress of Diagnosis and Treatment of Gastrointestinal Stromal Tumor

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